The applicant, Dr. Jerry Gurwitz, proposes a coordinated program of research, education, and practice in geriatrics under the auspices of the Harvard Medical School Division on Aging. Dr. Jerry Avorn, Associate Professor in the Gerontology Division of the Harvard Department of Medicine, will be the applicant's sponsor. The research program will incorporate a multidimensional approach to systematically examine the problem of drug-induced illness in the elderly employing a single medication category, the nonsteroidal anti-inflammatory drugs (NSAIDs), as a model. The program will include three components: (1) a population-based pharmaco-epidemiologic investigation of the adverse effects of NSAIDs on antihypertensive control in the elderly; (2) a complementary randomized, controlled clinical study examining the NSA]ID/blood pressure interaction as well as renal effects of NSAIDs in a population of ambulatory elderly subjects; and (3) a direct application of the results of the pharmacoepidemiologic and clinical investigations to the study of clinical decision-making in the care of elderly patients. The educational component will include the development of an innovative curriculum in geriatric clinical pharmacology to be employed at all levels of medical education from medical school to continuing education programs for practicing physicians. Clinical activities will emphasize long-term care, and will include the development of a program for the education and training of medical house officers in this setting. The substantial research, educational, and clinical resources of the Harvard Division on Aging will be available to assure accomplishment of the goals set out in this application.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08AG000510-02
Application #
3078698
Study Section
Biological and Clinical Aging Review Committee (BCA)
Project Start
1991-07-01
Project End
1996-06-30
Budget Start
1992-07-01
Budget End
1993-06-30
Support Year
2
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Harvard University
Department
Type
Schools of Medicine
DUNS #
082359691
City
Boston
State
MA
Country
United States
Zip Code
02115
Willison, D J; Soumerai, S B; McLaughlin, T J et al. (1998) Consultation between cardiologists and generalists in the management of acute myocardial infarction: implications for quality of care. Arch Intern Med 158:1778-83
Guadagnoli, E; Shapiro, C L; Weeks, J C et al. (1998) The quality of care for treatment of early stage breast carcinoma: is it consistent with national guidelines? Cancer 83:302-9
Gurwitz, J H; Yeomans, S M; Glynn, R J et al. (1998) Patient noncompliance in the managed care setting. The case of medical therapy for glaucoma. Med Care 36:357-69
Guadagnoli, E; Weeks, J C; Shapiro, C L et al. (1998) Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 16:101-6
Gurwitz, J H; Kalish, S C; Bohn, R L et al. (1997) Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol 50:953-9
Chandra, H; Yarzebski, J; Goldberg, R J et al. (1997) Age-related trends (1986-1993) in the use of thrombolytic agents in patients with acute myocardial infarction. The Worcester Heart Attack Study. Arch Intern Med 157:741-6
Monette, J; Gurwitz, J H; Rochon, P A et al. (1997) Physician attitudes concerning warfarin for stroke prevention in atrial fibrillation: results of a survey of long-term care practitioners. J Am Geriatr Soc 45:1060-5
Monane, M; Bohn, R L; Gurwitz, J H et al. (1997) The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens 10:697-704
McLaughlin, T J; Soumerai, S B; Willison, D J et al. (1997) The effect of comorbidity on use of thrombolysis or aspirin in patients with acute myocardial infarction eligible for treatment. J Gen Intern Med 12:1-6
Guadagnoli, E; Shapiro, C; Gurwitz, J H et al. (1997) Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer. J Clin Oncol 15:2338-44

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